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HomeMy WebLinkAboutBuilding Permit #789-2017 - 1600 OSGOOD STREET 5/1/2018 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: '7Y-9 —L4017 Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page CS75 w wVr- / L LOCATION Print', ` Tnt , PR,OP,ERTYtONNER . JQ&Year�®Id)Structure yens noP MAF1N®; __ _ PARCEL:. ZONING'DIS�TRICT ____ Histone District, yes nos - _ , Machine Shop Village; yes __Tno, _-_ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition El Two or more family El Industrial El Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg El Others: ❑ Demolition ❑ Other D`Septic .,1Nell gfFlgodplain, �-Wetlands. ' �=Water-shedtDistrict; DESCRIPTION OF WORK TO BE PERFORMED: c% S Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: 4 CONTRACTOR �- �° � � a ` Nane� G>/.3i% �i�/�I���s one: - �=_-� P Address: Supervisor's Const"ructlon,Lidense: Hosie.Improvement;License `x Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ Crt5-v FEE: $ Check No.: Receipt No.: f NOTE: Persons contracting with unregistered contractors do not have access to the guara fund _.... . ;Signature:of Agent/Qwner _Signature of_contractor.: Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans'❑ TYPE-OF.SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM - DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS t Zori;ng hoard of Appeals: variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/s;nnature Date Driveway Permit ]DPW To'vvL, Engineer: Signature: Located 384 Osgood Street FIRE DEPAKTMENT - Temp Dumpster on site yes no Located at'124 Mair.,Street Fire Department signatureldate COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions_ Total land area, sq. ft.: ELECTRICAL: Movement of[Deter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A-F and G min.$100-$1000 fine NOTES and DATA— (For department use El Notified for pickup - Date t = Doc.Building Permit Revised 2010 Building Department Tine fol[owing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (if Applicable) ❑ Engineering Affidavits for Engineered products VOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products DOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cf.-ses if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the; apn-,al period is over. The applicant must then get this recorded at the Registiy of Deeds. One copy and proof of recording must be- submAted with the building application Doc: Doc.Building Permit Revised 2012 Location � el oo 0 S J �r fa U7 No. `� Gy 7 Date • - TOWN OF NORTH ANDOVER ` Certificate of Occupancy $ Building/Frame Permit Fee $ t Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 160 r� rBuilding Inspector r 1 ->t NORTH q W, Ic . : ve" 'o 04 . lbi-2ml 4 Z oLAKI h ver, Mass, Z • r't ( � 0 7 A- COCHICKIWICK 7a ASR^TE D P**p 7s u BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System THIS CERTIFIES THAT .....N+.44!t...tI.q4.woev.-Ics.............................................................. BUILDING INSPECTOR has permission to erect .......................... buildings on Mp.QO.... Q.�,� �. f Foundation r Rough t0 be occupied as ... ... .... .....e .0.4%V 04.....r..................... ..... .......... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR. .. UNLESS CONSTRUCTION ST S Rough Service ....................... .... . ... .. ................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. cubicle connection inc. Estimate 127 Conant Street Date Estimate# 2/21/2017 1089 Name/Address Mentor Networks 1600 Osgood Street North Andover ma. Project Description Qty Rate Total Labor Reg rate 14,000.00 14,000.00 Quote to build out cubicles and private offices in new space located on 3rd floor Total $14,000.00 A CERTIFICATE 4F LIABILITY INSURANCE 8022 2�6 0�) THIS CERTIFICATEIS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: PAYCHEX INSURANCE AGENCY INC PHOrm,Esq: FAc,Ne>: (888) 443-6112 210705 P: F: (888) 443-6112 E-MAIL ADDRESS: PO BOX 33015 INSURERS)AFFORDING COVERAGE NAICN SAN ANTONIO TX 78265 INSURER A: Hartford Casualty Ins Co 29424 INSURED INSURER B INSURER C CUBICLE CONNECTIONS INC INSURER D: 127 CONANT ST INSURER E DANVERS MA 01923 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OFJNSORfNCE ADDL SUER POLICYNUAMER POLICYEFF POLICYEXP D LIMJTS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS-MADE OCCUR PRAEM SES EaEocaurence $ MED EXP(Any one person) PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICYD PET❑LOC PRODUCTS-COMPIOP AGG $ OTHER: AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTIONS $ WORAERSCOMPEA'SA370N PER OTH- AND EMPLOYBRS'LLMMY X STATUTE ER ANY PROPRIETOR/PARTNERIEXECUTIVE YIN E_L EACH ACCIDENT $1 0 0 0 0 0 0 OFFICEMMEMBER EXCLUDED? ❑ N/A , I A (Mandatory in NH) 76 WEG EU1185 07/30/2016 07/30/2017 E.LDISEASE-EAEMPLOYEE $1, 000, 000 If yes,describe under 111, 000, 000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Mentor Networks AUTHORIZED REPRESENTATIVE 1600 OSGOOD ST NORTH ANDOVER, MA 01845 / ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD / c co , t\A 7.h �.__. . 21-1 �P! 0 q7 4 at Al ff 1 } y h� e„- Wv� � 1 • k E - i t •v / s P • Y k f I !s! ; t bZ 6t!n.-h�vt 1 M